<?php js_validate();?>
<form id="form-validated" class="input" action="<?php echo $own_links;?>save" method="post">
		<input type="hidden" name="cabang_id" id="cabang_id" value="<?php echo isset($val->cabang_id)?$val->cabang_id:'';?>" />
		<table class="table-form" width="100%">
			<tr>
				<td>Nama Asuransi</td>
				<td><input type="text" id="cabang_name" name="cabang_name" class="validate[required]"size="50" value="<?php echo isset($val->cabang_name)?$val->cabang_name:'';?>" /></td>
			</tr>
			<tr>
				<td>Email Asuransi</td>
				<td><input type="text" id="cabang_email" name="cabang_email" class="validate[required]"size="30" value="<?php echo isset($val->cabang_email)?$val->cabang_email:'';?>" /></td>
			</tr>
			<tr valign="top">
				<td>Alamat Asuransi</td>
				<td><textarea id="cabang_address" name="cabang_address" cols="55" rows="3" class="validate[required]"><?php echo isset($val->cabang_address)?$val->cabang_address:'';?></textarea></td>
			</tr>
			<tr><td colspan="2">&nbsp;</td></tr>
			<tr>
				<td><input type="reset" onclick="document.location='<?php echo $own_links;?>'" class="btnbatal" value="Batal" /></td>
				<td align="right"><input type="submit" class="btnsimpan" id="btn-simpan" value="Simpan" /></td>
			</tr>
		</table>
	</form>
